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Prognostic Findings for a Trauma Patient Admitted with Head Injuries and a Glasgow Coma Score of 3

Description

Demetriades et al identified prognostic factors for a patient with head injuries and an admission Glasgow coma scale (GCS) score of 3. These can help identify patients who have a worse prognosis in an overall grim situation. The authors are from the University of Southern California Los Angeles.


Prognostic factors on admission:

(1) penetrating head trauma

(2) head abbreviated injury score (AIS)

(3) systolic blood pressure

(4) age in years

 

Prognostic Factor

Finding

Points

penetrating head trauma

absent (blunt trauma only)

0

 

present

1

head AIS

<= 3

0

 

>= 4

1

systolic blood pressure

>= 90 mm Hg

0

 

< 90 mm Hg

1

age

<= 55 years

0

 

> 55 years

1

 

where:

• A head AIS of 6 is an unsurvivable injury. The rest of the score would be pointless.

 

total number of adverse prognostic factors =

= SUM(points for all 4 factors)

 

Interpretation:

• minimum number of adverse prognostic factors: 0

• maximum number of adverse prognostic factors: 4

• The prognosis goes from guarded to very poor as the number of adverse prognostic factors increase.

• Only 23% of patients in the study set of 760 patients survived, and only 10% of these had a good functional outcome


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